2015 HSC Section 1 Book of Articles

Original Investigation Research

Mandibular Distraction Osteogenesis

in these patientswhohave clinically significant respiratorydis- tress due tomicrognathia. A proposed treatment algorithm is presented in Figure 3 .

results were essentially unchanged, suggesting minimal im- pact of this possible bias. Regardless, the issue of confound- ing by indication is an important one, which is why the out- comes of surgical successwere addressed in separate analyses in this study. Within the context of this broad retrospective study, we did not attempt to directly compare the 2 primary interventions of tracheotomy andMDO except with respect to overall rates of complications. However, it is clear from our analysis that patients who were syndromic or had additional airway disease abnormalities were more likely to have an ini- tial tracheotomy to addressmultilevel disease.Mandibular dis- traction osteogenesis should be considered only as an initial procedure in a setting inwhich there is no other indication for tracheotomy, such as multilevel airway obstruction, ventila- tor dependence, or persistent dysphagia and aspiration. Be- cause patients with CFM-Goldenhar syndrome were found to have independently lower odds of successwithMDOthanother syndromic conditions,wewouldnot recommendprimaryMDO

Conclusions Our study evaluated a large cohort of children that had under- gone MDO. In our study we demonstrated a high rate of sur- gical success for MDO with a low rate of complications, par- ticularly among patients treated with distraction as an initial procedurewithout anexisting tracheotomy. However, it is clear that patients treatedwith tracheotomy initially aremore likely to be syndromic and complex, requiring greater numbers of distractions and airway procedures. In addition, patients with CFM–Goldenhar syndromehave a decreasedprobabilityof sur- gical success comparedwith patients with other types of syn- dromes or nonsyndromic Pierre Robin sequence.

14 . Zim S. Treatment of upper airway obstruction in infants with micrognathia using mandibular distraction osteogenesis. Facial Plast Surg . 2007;23(2):107-112. 15 . Mandell DL, Yellon RF, Bradley JP, Izadi K, Gordon CB. Mandibular distraction for micrognathia and severe upper airway obstruction. Arch Otolaryngol Head Neck Surg . 2004;130(3): 344-348. 16 . McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg . 1992;89(1):1-8. 17 . Denny AD, Talisman R, Hanson PR, Recinos RF. Mandibular distraction osteogenesis in very young patients to correct airway obstruction. Plast Reconstr Surg . 2001;108(2):302-311. 18 . Scott AR, Tibesar RJ, Lander TA, Sampson DE, Sidman JD. Mandibular distraction osteogenesis in infants younger than 3 months. Arch Facial Plast Surg . 2011;13(3):173-179. 19 . Ow AT, Cheung LK. Meta-analysis of mandibular distraction osteogenesis: clinical applications and functional outcomes. Plast Reconstr Surg . 2008;121(3):54e-69e. 20 . Kolstad CK, Senders CW, Rubinstein BK, Tollefson TT. Mandibular distraction osteogenesis: at what age to proceed. Int J Pediatr Otorhinolaryngol . 2011;75(11):1380-1384. 21 . Evans AK, Rahbar R, Rogers GF, Mulliken JB, Volk MS. Robin sequence: a retrospective review of 115 patients. Int J Pediatr Otorhinolaryngol . 2006;70(6):973-980. 22 . Evans KN, Sie KC, Hopper RA, Glass RP, Hing AV, CunninghamML. Robin sequence: from diagnosis to development of an effective management plan. Pediatrics . 2011;127(5): 936-948. 23 . Rogers GF, Lim AA, Mulliken JB, Padwa BL. Effect of a syndromic diagnosis on mandibular size and sagittal position in Robin sequence. J Oral Maxillofac Surg . 2009;67(11):2323-2331.

ARTICLE INFORMATION Submitted for Publication: September 6, 2013; final revision received December 14, 2013; accepted January 6, 2014. Published Online: February 27, 2014. doi:10.1001/jamaoto.2014.16. Author Contributions: Dr Lam had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Lam, Shikary, Uribe-Rivera, de Alarcon, Gordon. Acquisition of data: Lam, Shikary, Uribe-Rivera. Analysis and interpretation of data: Lam, Tabangin, Shikary, Meinzen-Derr, Billmire. Drafting of the manuscript: Lam, Meinzen-Derr. Critical revision of the manuscript for important intellectual content: Lam, Tabangin, Shikary, Uribe-Rivera, de Alarcon, Billmire, Gordon. Statistical analysis: Lam, Tabangin, Shikary, Meinzen-Derr. Administrative, technical, and material support: Uribe-Rivera, Billmire. Study supervision: Lam, de Alarcon, Billmire, Gordon. Conflict of Interest Disclosures: None reported. Previous Presentation: This study was presented at the American Society of Pediatric Otolaryngology Spring Meeting; April 19-22, 2012; San Diego, California. REFERENCES 1 . Robin P. A fall of the base of the tongue considered as a new cause of nasopharyngeal respiratory impairment: Pierre Robin sequence, a translation: 1923. Plast Reconstr Surg . 1994;93(6):1301-1303. 2 . Meyer AC, Lidsky ME, Sampson DE, Lander TA, Liu M, Sidman JD. Airway interventions in children with Pierre Robin sequence. Otolaryngol Head Neck Surg . 2008;138(6):782-787. 3 . Sedaghat AR, Anderson IC, McGinley BM, Rossberg MI, Redett RJ, Ishman SL. Characterization of obstructive sleep apnea before

and after tongue-lip adhesion in children with micrognathia. Cleft Palate Craniofac J . 2012;49(1):21-26. 4 . Denny AD, Amm CA, Schaefer RB. Outcomes of tongue-lip adhesion for neonatal respiratory distress caused by Pierre Robin sequence. Schlöndorff G. Indications, complications, and surgical techniques for pediatric tracheostomies: an update. J Pediatr Surg . 2002;37(11):1556-1562. 6 . Perkins JA, Sie KC, Milczuk H, Richardson MA. Airway management in children with craniofacial anomalies. Cleft Palate Craniofac J . 1997;34(2):135-140. 7 . Rachmiel A, Srouji S, Emodi O, Aizenbud D. Distraction osteogenesis for tracheostomy dependent children with severe micrognathia. J Craniofac Surg . 2012;23(2):459-463. 8 . Mudd PA, Perkins JN, Harwood JE, Valdez S, Allen GC. Early intervention: distraction osteogenesis of the mandible for severe airway obstruction. Otolaryngol Head Neck Surg . 2012;146(3):467-472. 9 . Hammoudeh J, Bindingnavele VK, Davis B, et al. Neonatal and infant mandibular distraction as an alternative to tracheostomy in severe obstructive sleep apnea. Cleft Palate Craniofac J . 2012;49(1):32-38. 10 . Tibesar RJ, Scott AR, McNamara C, Sampson D, Lander TA, Sidman JD. Distraction osteogenesis of the mandible for airway obstruction in children: long-term results. Otolaryngol Head Neck Surg . 2010;143(1):90-96. 11 . Senders CW, Kolstad CK, Tollefson TT, Sykes JM. Mandibular distraction osteogenesis used to treat upper airway obstruction. Arch Facial Plast Surg . 2010;12(1):11-15. 12 . Miloro M. Mandibular distraction osteogenesis for pediatric airway management. J Oral Maxillofac Surg . 2010;68(7):1512-1523. 13 . Tibesar RJ, Sidman JD. Mandibular distraction osteogenesis in the pediatric patient. Curr Opin Otolaryngol Head Neck Surg . 2008;16(6):548-554. J Craniofac Surg . 2004;15(5):819-823. 5 . Kremer B, Botos-Kremer AI, Eckel HE,

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